摘要
目的 探讨和指出胸部穿透伤救治中的失误、难点、危险因素、并发症及防范措施。 方法 回顾总结的胸部穿透伤 318例 ,重点分析诊治错误和并发症。 结果 胸腔伤的物理和X线漏误诊率为 11.1% (35 316 ) ,但致使误治率仅为 4.1% (13 316 )。 2 4例心脏大血管损伤初期漏误诊 5例。 2 8例膈肌损伤早期漏诊 9例。 2 6 7例次胸腔闭式引流操作失误 11例次 (4 .1% )。发生需剖胸处理的并发症 17例。全组治愈 30 8例 ,死亡 10例 ,死亡率 3.2 %。 结论 救治胸部穿透伤有 5个须重点防范的危险因素 :(1)火器伤伴有肺挫伤 ;(2 )迟发性血和 (或 )气胸 ;(3)缺乏心脏压塞征和血流动力学尚稳定的心脏伤 ;(4 )腹部症状体征轻微或缺如的膈肌损伤 ;(5 )
Objective To identify the key points and the prevention of iatrogenic complications in the management of penetrating chest injuries. Methods Retrospective study was conducted on 318 patients with penetrating chest injury with the emphasis on errors in diagnosis and treatments and iatrogenic complications. Results Mis- or missed diagnosis accounted for 11.1% (35/316) of penetrating pleural injuries on initial physical and radiological examination, but only 4.1% (13/316) led to a final misdiagnosis. Among 24 patients with cardiac and vascular injuries, 5 were missed or delayed diagnosis, and it was 9 in 28 diaphragmatic injuried patients. Incorrect closed thoracic drainage occurred in 11 cases (4.1%). In this series, 17 patients had to undergo thoracic surgical procedures for the complications. Conclusions The present study identifies five factors prone to mis- or missed diagnosis in the management of penetrating chest injuries: (1) gunshot wounds combining lung contusion, (2)delayed hemothorax or/and pneumothorax, (3)cardiac wounds with stable hemodynamics and without tamponade signs, (4)diaphragmatic injuries with slight or non-abdominal sings, (5)careless manipulation for closed thoracic drainage.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2000年第5期283-285,共3页
Chinese Journal of Trauma
关键词
胸部损伤
创伤
贯通性
诊断
治疗
Chest injuries
Wounds, penetrating
Diagnosis and management of trauma
